December 13, 2011

Mystery kidney disease in Central America

A mysterious epidemic is sweeping Central America - it's the second biggest cause of death among men in El Salvador, and in Nicaragua it's a bigger killer of men than HIV and diabetes combined. It's unexplained but the latest theory is that the victims are literally working themselves to death.

In the western lowlands of Nicaragua, in a region of vast sugar cane fields, sits the tiny community of La Isla.

The small houses are a patchwork of concrete and wood. Pieces of cloth serve as doors.

Maudiel Martinez emerges from his house to greet me. He's pale, and his cheekbones protrude from his face. He hunches over like an old man - but he is only 19 years old.

"The way this sickness is - you see me now, but in a month I could be gone. It can take you down all of a sudden," he says.

Maudiel's kidneys are failing. They do not perform the essential function of filtering waste from his body - he's being poisoned from the inside.

When he got ill two years ago, he was already familiar with this disease and how it might end. "I thought about my father and grandfather," he says. Both died of the same condition. Three of his brothers have it too.

All of them worked in the sugar cane fields.

Kidney disease has killed so many men here that locals now call their community not simply La Isla - which means "The Island" - but La Isla de las Viudas - "The Island of the Widows."

The epidemic extends far beyond Nicaragua. It's prevalent along the Pacific coast of Central America - across six countries.

"It is important that the chronic kidney disease (CKD) afflicting thousands of rural workers in Central America be recognised as what it is - a major epidemic with a tremendous population impact," says Victor Penchaszadeh, a clinical epidemiologist at Columbia University in the US, and consultant to the Pan-American Health Organization on chronic diseases in Latin America.

El Salvador's health minister recently called on the international community for help. She said the epidemic is "wasting away our populations".

Heat stress

At a health clinic in El Salvador, in the farming region of Bajo Lempa, Dr Carlos Orantes recently found that a quarter of the men in his area suffered from it.

What's more, he says, most of the men who are ill show no signs of high blood pressure or diabetes - the most common causes of CKD elsewhere in the world.

"Most of the men we studied have CKD from unknown causes," he says.

What the men in his area have in common is they all work in farming. So Dr Orantes thinks a major cause of their kidney damage is the toxic chemicals - pesticides and herbicides - that are routinely used here in agriculture.

"These chemicals are banned in the United States, Europe and Canada, and they're used here, without any protection, and in large amounts that are very concerning," he says.

But he's not ready to rule out other possible causes. For instance, the overuse of painkillers can damage the kidneys, and so can drinking too much alcohol. Both are major problems here, he says.

The full article also mentions diabetes, HIV, viral hepatitis, malaria, and tuberculosis as causes.

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A mysterious epidemic is sweeping Central America - it's the second biggest cause of death among men in El Salvador, and in Nicaragua it's a bigger killer of men than HIV and diabetes combined. It's unexplained but the latest theory is that the victims are literally working themselves to death.

In the western lowlands of Nicaragua, in a region of vast sugar cane fields, sits the tiny community of La Isla.

The small houses are a patchwork of concrete and wood. Pieces of cloth serve as doors.

Maudiel Martinez emerges from his house to greet me. He's pale, and his cheekbones protrude from his face. He hunches over like an old man - but he is only 19 years old.

"The way this sickness is - you see me now, but in a month I could be gone. It can take you down all of a sudden," he says.

Maudiel's kidneys are failing. They do not perform the essential function of filtering waste from his body - he's being poisoned from the inside.

When he got ill two years ago, he was already familiar with this disease and how it might end. "I thought about my father and grandfather," he says. Both died of the same condition. Three of his brothers have it too.

All of them worked in the sugar cane fields.

Kidney disease has killed so many men here that locals now call their community not simply La Isla - which means "The Island" - but La Isla de las Viudas - "The Island of the Widows."

The epidemic extends far beyond Nicaragua. It's prevalent along the Pacific coast of Central America - across six countries.

"It is important that the chronic kidney disease (CKD) afflicting thousands of rural workers in Central America be recognised as what it is - a major epidemic with a tremendous population impact," says Victor Penchaszadeh, a clinical epidemiologist at Columbia University in the US, and consultant to the Pan-American Health Organization on chronic diseases in Latin America.

El Salvador's health minister recently called on the international community for help. She said the epidemic is "wasting away our populations".

Heat stress

At a health clinic in El Salvador, in the farming region of Bajo Lempa, Dr Carlos Orantes recently found that a quarter of the men in his area suffered from it.

What's more, he says, most of the men who are ill show no signs of high blood pressure or diabetes - the most common causes of CKD elsewhere in the world.

"Most of the men we studied have CKD from unknown causes," he says.

What the men in his area have in common is they all work in farming. So Dr Orantes thinks a major cause of their kidney damage is the toxic chemicals - pesticides and herbicides - that are routinely used here in agriculture.

"These chemicals are banned in the United States, Europe and Canada, and they're used here, without any protection, and in large amounts that are very concerning," he says.

But he's not ready to rule out other possible causes. For instance, the overuse of painkillers can damage the kidneys, and so can drinking too much alcohol. Both are major problems here, he says.

The full article also mentions diabetes, HIV, viral hepatitis, malaria, and tuberculosis as causes.